Authored by Yalim SD*
Abstract
Objective: This study compares the effectiveness of fluocortolone and fluocortolone+acyclovir treatments in patients with Bell palsy.
Materials and Methods: Thirty-eight patients with Bell palsy who received fluocortolone treatment and twenty one patients with Bell palsy who received fluocortolone+acyclovir treatment were evaluated according to the full recovery times, stapes reflexes and electromyography measurements.
Results: There was no significant difference between the treatment groups in terms of facial function, recovery time, stapes reflex and electromyography measurements.
Conclusion: Both fluocortolone and fluocortolone+acyclovir treatments are effective in the treatment of Bell palsy.
Keywords: Bell palsy; Treatment; Stapes; Electromyography
Introduction
Bell palsy is idiopathic, sudden onset and the most common cause of facial paralysis. Herpes simplex virus is the causative pathogen [1]. In a study which was done in 1996, herpes simplex virus genomes were found in the patients’ facial nerve fluids and herpes simplex virus genome reactivation was observed in the geniculate ganglion in 79 % of the patients [2]. Also, in animal studies herpes simplex virus has been shown to form facial paralysis. Varicella zoster virus reactivation was also proposed in the etiology of Bell palsy. Acyclovir is used in the treatment of herpes simplex virus and varicella zoster virus infections [3]. Acyclovir interacts with herpes virus DNA polymerase and inhibits DNA replication [2]. Steroid treatment has been found to be effective in the treatment of Bell palsy [2]. According to the metanalysis of Ramsey corticosteroids increased the treatment seventeen percent and this was statistically significant. Regardless of the severity of the palsy, the treatment should be started to all patients as soon as possible [4]. Recently it has been proposed that combined steroid and acyclovir treatment has been found to be more effective than the steroid treatment alone [2]. Adaour et al. reported that acyclovir+ prednisone treatment is more beneficial than prednisone treatment alone in patients with Bell palsy [5]. Hato et al reported that valacyclovir+steroid treatment had a 96% recovery rate; only steroid treatment was 89% successful and the difference was statistically significant [6]. However, before giving a definitive advice about the effect of antiviral treatment, there is a need for information from multicentric, randomized and double-blind studies with large patient populations with at least twelve months of follow up. Therefore, we planned to investigate the effects of fluocortolone and fluocortolone +acyclovir treatment on early and late recovery times and full recovery time, stapes reflexes and electromyography measurements in the treatment of Bell palsy.
Introduction
Fifty nine patients with Bell palsy were investigated retrospectively. The study was approved by the local ethic committee and the informed consent was taken from all of the patients. The patients were divided into two groups according to the drugs they used. The first group (38 patients) received only oral fluocortolone, the second group (21 patients) received fluocortolone and acyclovir. The inclusion criteria of the study were as follows: 1) patients who were admitted within 72 hours after the onset of paralysis were included in the study. 2) antiviral treatment had been given to the patients who had a viral infection recently. 3) all of the patients received 250 mg intravenous methylprednisolone at the beginning of the treatment. 4) the patients with Ramsey Hunt syndrome were excluded from the study.
Steroid and antiviral treatment given patients received acyclovir 2000 mg/day (Asiviral tablet 400 mg; Terra,Turkey) for five days and 1 mg/kg/day fluocortolone (Ultralan 20 mg tablet, Bayer Schering Pharma AG, Germany) for three days and then lowering 10 mg every three days. The patients were evaluated in terms of presence of diabetes mellitus, day of treatment start, full recovery time, stapes reflex and electromyography measurements. Facial functions were classified according to the House-Brackman classification before and after the treatment. The effects of drugs on facial nerve functions were evaluated with the nerve excitability and the voluntary facial movements. The decrease in the electromyography thresholds greater than 3.5 mA on the affected side was taken as a sign of a decrease in the nerve excitability. Facial nerve function was graded as complete, partial or absent according to electromyography. All of the patients were followed until full treatment.
Data analysis
SPSS.17 package programmed was used for data analysis. The datas in the study were given as mean ± standard deviation. Levene test was used to test homogeneity of group variances. The independent samples t-test used to compare means of the groups. Pearson’s chi square test is used to test if there is a relationship between two categorial variables. Statistical significance level was taken as 0.05 in the analysis.
Results
The ages of the patients was between 22 and 77. (mean 53.9±13.9) Twenty six patients were with diabetes mellitus. In the first group of patients (steroid treatment group) the average time to start treatment was 2.9 days and the average recovery time was 35.4 days. In the second group (steroid+antiviral treatment group) the average time to start treatment was 4.8 days and the average recovery time was 23.1 days respectively. Stapes reflex improved in 6.8 % of the patients. The facial functions of the patients were given in Table 1. The electromyography measurements of the patients were given in Table 2 (Table 1& 2).
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